Home is where the chart is

Technology is giving physicians more flexibility and some new responsibilities

by KATHERINE ELPHICK  May 2010

Thinking of setting up a home office? You’re not alone. Thanks to advances in technology and a changing work environment, physicians are becoming less tied to traditional offices, as more tasks can be done offsite.

Take imaging, for example. The digitization of many hospital radiology departments has been a real boon to practitioners, according to the President of the Canadian Association of Radiology, Dr Edward Lyons, OC.

"It has made a huge difference for weekend and evening call," explains Lyons. "Instead of schlepping into the hospital in the middle of the night, images can be read from home, the cottage, or really anywhere. All you need is a laptop and access to high-speed Internet."

Computerizing radiology paperwork and images has been a huge advantage to the profession and patients, explains Lyons. Because information can be shared with other hospitals, doctors and clinics across the country, it decreases unnecessary repeat examinations.

The ability to offer radiology to under-serviced areas is another advantage. "Images can be transmitted anywhere, so I can read films (while the tests are taking place) from hundreds of kilometres away," explains Lyons, who practices in Winnipeg, Manitoba.

Digital domain

In recent years, there has been a big push by Canada Health Infoway to computerize imaging. As a not-for-profit organization funded by the federal government, Infoway works with the provinces to accelerate the development of electronic health information systems. "They have offered incentives to the provinces across the country to bring radiology departments into the digital world," Lyons explains.

Infoway has also been encouraging other types of physicians, specifically family practitioners to go digital. The electronic health record also enables doctors to catch up on office work from home. "If the office is paperless, and all files are computerized, a physician can access files from anywhere in the world as long as they have access to the Internet," explains Greg O’Brien of Nordat, a software development company specializing in data management. Even medical billing can be done from the comfort of home.

"It’s really easy to set things up for remote access," says O’Brien. But, it's the security issues that you have to be aware of.”

A popular remote access software company is Log Me In(logmein.com). The software allows you to access and back up your home or work computer from anywhere with an Internet connection, even from your iPhone.

Some physicians, like Dr Brad Dibble (who, for the record, is the author's husband), are installing home offices to accommodate this new-found flexibility. Thanks to recent technology, the Barrie, Ontario-based cardiologist is able to read web-based ECGs from home (or anywhere with Internet access). He also dictates charts and prepares lectures from his home office.

While he still maintains a traditional practice, he welcomes the idea of working more from home. "It’s great because it allows me to spend more time at home with my family," explains Dibble.

Legal ease

While the flexibility is a huge boon for physicians, there are serious issues to consider as well. To get the legal perspective, we contacted the Canadian Medical Protective Association(cmpa-acpm.ca).

"It's important to recognize that the CMPA does not regulate or set standards regarding home-based practices," explained Barb Wilson, their senior communications advisor. "Rather, its role is to provide information to assist physician-members who are considering setting up home-based offices." Here's what the CMPA recommends.

Compliance with legislation
Most privacy statutes impose obligations on physicians to take all precautions to minimize the risk of loss, theft or authorized access of that information. Physicians need to comply with requirements from regulatory authorities (like their College) and, in some jurisdictions, privacy legislation regarding the collection, use and disclosure of personal information.

Establish a privacy policy
Physicians are responsible for privacy policies in their privately owned office or clinic. It's important to have sound privacy policies and to make sure everyone (staff and physicians) knows and abides by them.
Confidentiality

The CMPA suggests that when receiving or disposing of test results, physicians exercise great caution to maintain confidentiality. The responsibility for keeping patients' medical information confidential is an integral part of medical practice.

Destruction of records
Patient health information should be kept only for as long as it is required, for the purpose for which it was collected, and in accordance with the retention requirements specified in jurisdictional legislation. The information must then be disposed of in a manner that ensures permanent destruction and complies with the requirements of the respective regulatory authorities (College).

Electronic safeguards
Electronic patient information should be appropriately safeguarded. Best practices and, in some jurisdictions, legislation dictate that this include password protection and encryption. Reasonable protection also includes the use of antivirus/antispyware applications as well as regular backups, preferably to an offsite location.

Portability of records
There are some jurisdictions, such as Ontario, where legislation prohibits the removal of records from hospitals, however, this is specific to paper records. In the case of electronic records, secure remote access by treating physicians would be fairly normal.

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Design: Plan it out

Kimberley Seldon, the principal designer for the Kimberley Seldon Design Group, as well the decorating editor of Canada’s Style at Home magazine and author of 500 Ideas for Small Spaces) (CPi Publishing), says home offices are more popular than ever. "About 75 percent of the homes we design and decorate have at least one home office." Here are a few things to keep in mind.

Scope
Some physicians opt for dedicated offices complete with waiting and examination rooms, while others merely want a residential workspace where they can catch up on paperwork or reading Web-based tests.

Whatever your budget or working requirements, there's a lot that needs to be considered before setting up a home office. Whether you're renovating a guest room, taking over part of the basement, or building a completely dedicated medical office, the space must be comfortable, efficient and suit your personal work style.

Privacy
Noise, mess and privacy are key details to consider. "If you're part of a busy family, noise from adjacent rooms can be distracting. Conversely, if you have a baby sleeping and a fax machine or printer in the next room, the office space can be disruptive."

A completely private office allows its occupant free reign over clutter and stacks of paper. "If you have an office off the main hallway with glass or French doors leading to it, messiness can be stressful to those you live with," Seldon points out.

"Ideally, you want to be able to work without disrupting life in the rest of the house," explains Seldon. "It's also important to keep work out of the bedroom — for obvious reasons."

Lighting
Lighting should also be considered. "Task lighting is very important," says Jo Anne Stewart, Interior Design School coordinator at Georgian College in Barrie, Ontario. "Indirect lighting is also recommended because it creates welcoming spaces.”

Storage
Since productivity requires efficiency and organization, include plenty of storage and adequate filing space.

Independence
For those seeing clients or patients at a home office, Stewart recommends keeping it as separate from the main part of the dwelling as possible, including a separate entrance and washroom.

Trends
Home offices are even subject to design trends, according to Seldon. "We're adding refrigerators and sinks into serious home offices. And where budget allows built-ins are hiding shredders, printers and computers."